1. < Prostate Cancer

Can anyone share their experience with Pluvicto?

Posted by vcash @vcash, Apr 22, 2024

My 85 year old dad has prostate cancer that has metastasized to his bones. Zytiga is no longer effective. He is considering Pluvicto. I would appreciate input from those who have used Pluvicto.

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kenshabby | @kenshabby | 1 day ago
In reply to @redroadtraveler "I am 80 years old with stage IV prostate cancer which has metasasized throughout my bones...." + (show)
@redroadtraveler

I am 80 years old with stage IV prostate cancer which has metasasized throughout my bones. Been on various immunotherapy treatments for 3-4 years (most recent being Keytruda). All of them have run their course and are no longer effective.

I tried for several months to get the Pluvicto treatment but they didn't do it due to the FDA saying a person had to have had chemotherapy first. I elected to NOT have chemotherapy as it made no sense to me to kill off everything and hope that the good comes back faster than the bad.

Very recently, the manufacturer began to question the necessity for chemotherapy prior to Pluvicto and I am one of the first people to get Pluvicto without having had chemotherapy.

Pluvicto treatment protocol is an IV injection every six weeks for a total of six times. It is a heavy duty radiation treatment but it is NOT chemotherapy. It targets the cancer cells instead of the shotgun approach of chemotherapy.

I am halfway through my Pluvicto treatment. I have had three injections and will get number four in a week.

You will get detailed scans prior to the treatment, and the doctor will monitor your blood work closely and see how you are tolerating treatment before giving you the next injection.

After the injection, they turn you loose when your radiation level is three at a distance of three feet.

We joke that I "glow in the dark" after the injection but there is a certain amount of truth in that. I wanted this treatment for myself, but was concerned about "collateral damage" of radiation to anyone else around me. The official guidelines tell you to maintain a three foot distance from everyone for three days, and for seven days from pregnant women and small children (and by extension small animals like cats or dogs).

Every radioactive substance has a half-life and decays over time. I purchased a dosimeter (Geiger counter) from Amazon for about $100 to monitor my actual condition rather than simply going by their guidelines.

My personal experience is that, for me, the guidelines are not strict enough. I do not want to cause collateral radiation damage to anyone else, so monitor my radiation level daily at three feet, one and a half feet, and right next to my skin.

My personal protocol is to isolate myself for one week. I am alone in the bedroom, reading, binge watching Netflix, etc., leaving only briefly to get something to eat or go to the bathroom.

During week two I loosen up a bit, allowing brief contact such as a hug or a handshake, but no prolonged contact.

By the end of two weeks from my injection, my personal radiation level is down to zero at my skin, so I no longer have any danger of giving collateral radiation damage to anyone. At that point I resume sleeping in the same bed with my wife and have no issues with personal contact with others.

Everyone reacts differently to different treatments. I have tolerated it reasonably well. The worst side effect has been serious constipation. Also a moderate increase in fatigue.

I would like to get another scan now, halfway through treatment, but insurance won't pay for it. I will get another scan when all treatments are done so I will at least have a before and after reading on how effective (or ineffective) it has been.

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Is your tumor MSI-H?

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jeff Marchi | @jeffmarc | 1 day ago
In reply to @proftom2 "Interesting Pluvicto/PSA encounter after shot #3. My PSA went flying from 7 to 12. Just like..." + (show)
@proftom2

Interesting Pluvicto/PSA encounter after shot #3. My PSA went flying from 7 to 12. Just like that my hope deflated awaiting arrival of my PSA depression. My oncologist recommended stoping Pluvicto, and go right to scans and XTANDi. After he consulted with my Radiation Oncologist, Nuclear Oncologist, and other Oncologist, he/we/they came to the conclusion this looks like a PSA Flare. PSA Flares happen, the recommendation for the docs was to take one more injection, wait two weeks, do a Pet-Scan, and Bone scan and take it from here. This works well for me.

Anyone else have a PSA Flare-up while on Pluvicto?

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At the last Ancan.org Advanced prostate cancer meeting one of the participants had just had his first Pluvicto treatment.

He had a lot of mets and after the treatment, the PET scan showed him much clearer, but he had terrible side effects from the Pluvicto and can’t do another session for a while, if at all. Unfortunately, I don’t recall the specifics of all of his side effects other than extreme fatigue. His PSA did go down as well.

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kbrz | @kbrz | 15 hours ago

I did not have a "flare up". Fortunately, my PSA improved from a failed chemo (2 doses) PSA @ 13 Each test after Pluvicto started was under 1. The PSA test a month after Pluvicto ended (6 treatments) was 0.11. Scans came back with the words "Remarkable improvement". I had a total turn around, but 3/5/25 my PSA had risen to 4.01 and I'm now on a different Chemo. Now looking for a 2nd Pluvicto Treatment, but not clear as to FDA approval which I'll need to have Medicare cover the substantial expense. Original diagnoses 2016, I'm 74 now and still active. Looking for other options......

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smc24 | @smc24 | 9 hours ago

I did not have a PSA increase after any of my Pluvicto treatments, but a few other patients in my group did. To my knowledge (within my group of 80 or so), almost all of these patients had an eventual PSA decline. My non-medical, but very experienced Pluvicto patient opinion, including being one of the original clinical trial guinea pigs, believes your doctor is going down the correct path to proceed with the next treatment, then test for results. Stay focused, informed and do what needs to be done.

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lag | @lag | 7 hours ago
In reply to @proftom2 "Interesting Pluvicto/PSA encounter after shot #3. My PSA went flying from 7 to 12. Just like..." + (show)
@proftom2

Interesting Pluvicto/PSA encounter after shot #3. My PSA went flying from 7 to 12. Just like that my hope deflated awaiting arrival of my PSA depression. My oncologist recommended stoping Pluvicto, and go right to scans and XTANDi. After he consulted with my Radiation Oncologist, Nuclear Oncologist, and other Oncologist, he/we/they came to the conclusion this looks like a PSA Flare. PSA Flares happen, the recommendation for the docs was to take one more injection, wait two weeks, do a Pet-Scan, and Bone scan and take it from here. This works well for me.

Anyone else have a PSA Flare-up while on Pluvicto?

Jump to this post

My husband had all six Pluvicto infusions and didn't have a PSA flare, though he has had flares during and after other treatments. I know of other men who did have PSA flares during and after Pluvicto treatment. Most important is that you have had several oncologists analyze your situation and recommend that you have another Pluvicto infusion and then do scans two weeks after the infusion and decide on the path forward based on those results. It is terrific that you have had so many doctors consult on your case, and the recommendation they have made seems very reasonable. Good work by them, and by you! Good luck with your next steps.

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